The Psychodynamics of Depression

Depression - Psychodynamic Theory
I have been interested in the mechanics of depression since childhood, when my mother ‘suffered with her nerves’ - her explanation of what I now recognise as a very severe melancholia defined by Burton in 1621 as "a kind of dotage without a fever, having for his ordinary companions fear and sadness, without any apparent occasion" (p739). My interest was further compounded by my clients, Valerie and Jo, when it become apparent to me that depression is one of the most common and debilitating phenomenon that I will probably have to encounter in my role as a Counsellor.

Before beginning, it may be useful to briefly consider Freud’s warning that depression is not a homogenous group of conditions and that it probably involves more than one aetiology (Freud 1917). It can reflect underlying cultural and environmental trends in addition to physiological factors. (Desjerlais et al. 1995)

A review of the literature reveals that research relating to the nature and origins of the psychodynamic theory of depression is rich in contributions to the theme, thus this essay of necessity represents a high-altitude skim over a massive topic. I will concentrate on authors who have made some of the most seminal contributions to the development of the theory, namely Abraham, Freud, Jacobson, Klein and Mahler. (There are, in actuality, numerous other pioneers in the cultivation of this theory, such as Malan, Sandler, Spiz, Bibring, Rado, Blatt, Benedek, Lindemann, Kohut, some of which, due to word limit, I have not included). Bowlby‘s theory of attachment, although not psychodynamic per se, is also considered, because the way in which people relate to loss of attachment appears relevant to our understanding of depression. Schore, who describes the neuroscience of attachment and how the brain of the parent and infant interact, has also been included

The first thing we need to do is to be clear about four quite different ways that we may

References: ICD-10. Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines: World Health Organization, 1992. Abraham K. (1911-1968) Selected papers of Karl Abraham. New York: Basic Books Inc. Bion WR. (1962) Learning from Experience. London: Karnac.97. Blatt S. (1974). Levels of object representation in anaclitic and introjective depression Bowlby, J. (1969). Attachment and loss, Vol. 1: Attachment. New York: Basic Books. Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation-anxiety and anger. New York: Basic Books Brown & Harris (1986). Life events and illness. New York: The Guilford Press. Burton R. (1920) Anatomy of Melancholy. New York: Tudor Campbell & Hale (1991) Comer R. (1992). Abnormal psychology. New York: W. H. Freeman & Company Desjerlais et al (1995) World Mental Health: Problems and Priorities in Low-Income Countries Fairbairn W. (1952) Psychoanalytic Studies of the Personality. London: Routledge Freud S Freud S. (1914). On Narcisism. The standard edition of the complete psychological works of Sigmund Freud V. 14. London: Hogarth Press Freud S Freud S. (1914). Beyond the Pleasure Principle. The standard edition of the complete psychological works of Sigmund Freud V. 14. London: Hogarth Press Freud S Jacobson, E. (1964) The Self and the Object World. New York, International Universities Press Jacobson E Kernberg O, (1969) A contribution to the Ego-psychological critique of the Kleinian school. Int J Psychoanal 50: 317 - 33 Klein M Klein M. (1932). The psycho-analysis of children. London: Hogarth Press. Kohut H. (1971) The Analysis of the Self. New York, International Universities Press Lund C (1991) Psychotic depression: psychoanalytic psychopathology in relation to treatment and management, B J Psychiatry 158: 523 - 8 Mahler M. (1966). Some preliminary notes on the development of basic moods, including depression. Canadian Psychiatric Association Journal, 250- 258. Meltzer, D. (1998) The Kleinian Development (New Edition). London: Karnac Books O 'Shaughnessy E Parkin A (1976) Melancholia: A reconsideration, J Am Psychoanalytical Assoc. 24: 123 - 39 Parkes C Sandler J (1965) Notes on childhood depression. Int J Psychoanal 46: 88 - 96 Schore A (2003) Affect Regulation and The Repair of the Self New York: Segal H. (1973) Introduction to the work of Melanie Klein. London: Hogarth Press. Spitz R. (1946) Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood II. Psychoanalytical Study of the Child, 2, 53. Spillius, E. (1983). Some developments from the work of Melanie Klein., Int. J. Psychoanal., 64:321-332. Stengel E (1969). Suicide and Attempted Suicide. Harmondsworth: Pelican Books. Wetzel, J. W. (1984). Clinical handbook of depression. New York: Gardner Press. [2] introjection means to incorporate (characteristics of a person or object) into one’s own psychic unconsciously (Klein 1940). [5] “mirroring self object" is loosely translated as "mother," for in the external world it is most often the mother who performs the function. The gleam in her eye mirrors the infant’s self. (Bion 1962). [6] Mahler described separation-individuation as the steps through which the infant passes in developing a more stable awareness of separateness from the mother (1966).